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Items 1 to 26 of about 26
1. Packer RJ, Cohen BH, Cooney K: Intracranial germ cell tumors. Oncologist; 2000;5(4):312-20
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  • [Title] Intracranial germ cell tumors.
  • Intracranial germ cell tumors are a heterogeneous group of lesions which occur in children and adults.
  • Within the classification of intracranial germ cell tumors, there are a variety of different tumor types which carry different prognoses.
  • The diagnosis of an intracranial germ cell tumor usually requires histological information, but a subgroup of tumors will secrete specific tumor markers, including alpha-fetoprotein and beta-human chorionic gonadotropin, which may obviate the need for surgical intervention.
  • The management of intracranial germ cell tumors in both children and adults remains unsettled.
  • Germinomas have a good prognosis, as over 90% of patients can be effectively treated with radiation therapy.
  • The dose and volume of radiation therapy needed for disease control is not well established, and controversy exists concerning the need for whole brain or craniospinal radiation therapy for localized tumors.
  • Germinomas are also chemosensitive and recent reports suggest that the dose and volume of radiation therapy required for disease control can be lessened with the addition of adjuvant chemotherapy.
  • The outcome for patients with nongerminomatous germ cell tumors is less favorable.
  • Radiation therapy alone will result in disease control in 40%-60% of patients.
  • The addition of chemotherapy to radiation therapy may improve the rate of survival.
  • [MeSH-minor] Adult. Antineoplastic Agents / therapeutic use. Child. Chorionic Gonadotropin, beta Subunit, Human / analysis. Chorionic Gonadotropin, beta Subunit, Human / secretion. Humans. Prognosis. Survival Analysis. alpha-Fetoproteins / analysis. alpha-Fetoproteins / secretion

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  • [ErratumIn] Oncologist 2000;5(5):following 438. Coney, K [corrected to Cooney, K]
  • (PMID = 10964999.001).
  • [ISSN] 1083-7159
  • [Journal-full-title] The oncologist
  • [ISO-abbreviation] Oncologist
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] UNITED STATES
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Chorionic Gonadotropin, beta Subunit, Human; 0 / alpha-Fetoproteins
  • [Number-of-references] 63
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2. Ogawa K, Toita T, Nakamura K, Uno T, Onishi H, Itami J, Shikama N, Saeki N, Yoshii Y, Murayama S: Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors: a multiinstitutional retrospective analysis of 41 patients. Cancer; 2003 Jul 15;98(2):369-76
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  • [Title] Treatment and prognosis of patients with intracranial nongerminomatous malignant germ cell tumors: a multiinstitutional retrospective analysis of 41 patients.
  • BACKGROUND: The relative roles of surgical resection, radiotherapy, and chemotherapy in the management of patients with intracranial nongerminomatous malignant germ cell tumors have been controversial.
  • The authors retrospectively investigated the results of different treatment regimens in patients with these tumors.
  • They were grouped into patients with a good prognosis (n=3), an intermediate prognosis (n=24), and a poor prognosis (n=14) based on the histology of their tumors.
  • Fifteen patients (37%) underwent surgical resection and received radiotherapy, and 26 patients (63%) also received chemotherapy.
  • In the intermediate prognosis group, the 5-year actuarial overall survival rate was 44% for patients who underwent surgical resection and received radiotherapy (n=9) and 84% for patients who also received chemotherapy (n=15; P=0.01).
  • Patients in the poor prognosis group who underwent surgical resection and received radiotherapy (n=3) or who underwent incomplete resection and received both radiotherapy and chemotherapy (n=8) all died of disease, whereas 2 of 3 patients who underwent macroscopic total resection and received both radiotherapy and chemotherapy survived free of disease.
  • CONCLUSIONS: The treatment of patients with intracranial nongerminomatous malignant germ cell tumors should be based on tumor histology.
  • For patients who had a good prognosis (mature teratoma with germinoma), surgical resection and radiotherapy were sufficient; however, for patients in the intermediate prognosis group, multimodal treatment, including surgical resection, radiotherapy, and chemotherapy, was effective.
  • Conversely, for patients in the poor prognosis group, more intensive multimodal treatment, including macroscopic total resection, may improve the survival rate.
  • [MeSH-major] Brain Neoplasms / therapy. Neoplasms, Germ Cell and Embryonal / therapy
  • [MeSH-minor] Actuarial Analysis. Adolescent. Adult. Child. Child, Preschool. Combined Modality Therapy. Female. Humans. Male. Middle Aged. Neoplasm Recurrence, Local. Prognosis. Retrospective Studies. Survival Rate

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  • [Copyright] Copyright 2003 American Cancer Society.
  • (PMID = 12872359.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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3. Hsu YJ, Pai L, Chen YC, Ho CL, Kao WY, Chao TY: Extragonadal germ cell tumors in Taiwan: an analysis of treatment results of 59 patients. Cancer; 2002 Aug 15;95(4):766-74
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  • [Title] Extragonadal germ cell tumors in Taiwan: an analysis of treatment results of 59 patients.
  • BACKGROUND: Extragonadal germ cell tumors (EGCT) are rare.
  • Information regarding these tumors from the Far East is limited.
  • More investigations are warranted to define the optimal treatment.
  • Primary tumors occurred in the mediastinum (n = 27), retroperitoneum (n = 6), central nervous system (CNS; n = 24), and other sites (n = 2).
  • Patients received surgery, chemotherapy, radiotherapy, or a combination of treatment modalities as the primary treatment.
  • Of 24 patients with intracranial germ cell tumors, 16 had germinoma and 13 (81%) achieved CR with NED at 8-228 months (median duration, 104 months).
  • Four patients with mediastinal nonsemonimas treated with salvage chemotherapy died.
  • CONCLUSIONS: The treatment results of our patients with seminomatous EGCT are comparable to those of Western countries.
  • However, the treatment results of patients with nonseminomatous EGCT are not as good.
  • The reason for this discrepancy needs to be explored for a better treatment outcome of for patients in Taiwan with EGCT.
  • [MeSH-major] Central Nervous System Neoplasms / therapy. Mediastinal Neoplasms / therapy. Neoplasms, Germ Cell and Embryonal / therapy. Retroperitoneal Neoplasms / therapy
  • [MeSH-minor] Adult. Antineoplastic Combined Chemotherapy Protocols / adverse effects. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Child. Child, Preschool. Cisplatin / adverse effects. Cisplatin / therapeutic use. Combined Modality Therapy. Female. Germinoma / therapy. Humans. Infant. Male. Middle Aged. Retrospective Studies. Survival Analysis. Taiwan. Treatment Outcome

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  • [Copyright] Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10738
  • (PMID = 12209720.001).
  • [ISSN] 0008-543X
  • [Journal-full-title] Cancer
  • [ISO-abbreviation] Cancer
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] Q20Q21Q62J / Cisplatin
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4. da Silva NS, Cappellano AM, Diez B, Cavalheiro S, Gardner S, Wisoff J, Kellie S, Parker R, Garvin J, Finlay J: Primary chemotherapy for intracranial germ cell tumors: results of the third international CNS germ cell tumor study. Pediatr Blood Cancer; 2010 Mar;54(3):377-83
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  • [Title] Primary chemotherapy for intracranial germ cell tumors: results of the third international CNS germ cell tumor study.
  • BACKGROUND: The treatment of central nervous system (CNS) germ cell tumors (GCT) remains controversial.
  • The purpose of this study was to demonstrate efficacy of a chemotherapy only strategy, with less morbidity, when compared to regimens with irradiation.
  • METHODS: Between January 2001 and December 2004 newly diagnosed patients with CNS GCT were treated with one of two risk-tailored chemotherapy regimens.
  • Twenty-five patients aged 4 months to 24.5 years were stratified: Regimen A consisted of 4-6 cycles of carboplatin/etoposide alternating with cyclophosphamide/etoposide for low risk (LR) localized germinoma with normal cerebrospinal fluid (CSF) and serum tumor markers.
  • Seventeen (68%) patients achieved complete radiographic and marker responses after two courses and 19 (76%) after four courses of chemotherapy.
  • CONCLUSION: These intensive chemotherapy regimens proved less effective than irradiation containing regimens.
  • Our results indicate that, at the present time, standard treatment for CNS GCT continues to include irradiation either alone or combined with chemotherapy for pure germinomas and with chemotherapy for those with MMGCT.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / drug therapy. Neoplasms, Germ Cell and Embryonal / drug therapy
  • [MeSH-minor] Adolescent. Adult. Carboplatin / administration & dosage. Carboplatin / adverse effects. Child. Child, Preschool. Combined Modality Therapy. Cyclophosphamide / administration & dosage. Cyclophosphamide / adverse effects. Etoposide / administration & dosage. Etoposide / adverse effects. Female. Humans. Infant. Male. Treatment Outcome. Young Adult

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  • [Copyright] Copyright 2009 Wiley-Liss, Inc.
  • (PMID = 20063410.001).
  • [ISSN] 1545-5017
  • [Journal-full-title] Pediatric blood & cancer
  • [ISO-abbreviation] Pediatr Blood Cancer
  • [Language] eng
  • [Publication-type] Clinical Trial; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide; BG3F62OND5 / Carboplatin
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5. Fujiwara K, Uenohara H, Suzuki H, Sakurai Y: Intracranial germinoma with syncytiotrophoblastic giant cells in the cerebellopontine angle--case report. Neurol Med Chir (Tokyo); 2002 Mar;42(3):132-6
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  • [Title] Intracranial germinoma with syncytiotrophoblastic giant cells in the cerebellopontine angle--case report.
  • Gross total removal of the tumor was achieved.
  • Histological examination revealed that the tumor was a germinoma with syncytiotrophoblastic giant cells.
  • Whole central nervous system irradiation with cisplatin-etoposide chemotherapy was performed postoperatively.
  • Intracranial germ cell tumors in the CPA are very rare.
  • Total surgical removal followed by irradiation and chemotherapy will provide a good outcome.
  • [MeSH-minor] Adult. Chemotherapy, Adjuvant. Combined Modality Therapy. Craniotomy. Humans. Male. Radiotherapy, Adjuvant

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  • (PMID = 11936056.001).
  • [ISSN] 0470-8105
  • [Journal-full-title] Neurologia medico-chirurgica
  • [ISO-abbreviation] Neurol. Med. Chir. (Tokyo)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Japan
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6. Aoyama H, Shirato H, Ikeda J, Fujieda K, Miyasaka K, Sawamura Y: Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors. J Clin Oncol; 2002 Feb 01;20(3):857-65
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  • [Title] Induction chemotherapy followed by low-dose involved-field radiotherapy for intracranial germ cell tumors.
  • PURPOSE: To investigate the efficacy of chemotherapy followed by low-dose involved-field radiotherapy for the treatment of intracranial germ cell tumors (GCTs).
  • Etoposide and cisplatin (EP) were used for the treatment of solitary pure germinomas, and ifosfamide, cisplatin, and etoposide (ICE) were used for the treatment of other GCTs.
  • The dose schedule was 24 Gy for germinomas and 40 to 54 Gy for other GCTs.
  • All eight relapses (one pure germinoma, five HCG-beta-secreting germinomas, and two IMT/G), except one in a course of salvage treatment, were salvaged and free of disease at the last follow-up.
  • No decline was observed in the full-scale, verbal, or performance intelligence quotient at 12 to 51 months after the treatment in 11 patients.
  • Dose and volume can be reduced to 24 Gy in 12 fractions and involve a field set-up after EP chemotherapy for the treatment of pure germinomas.
  • [MeSH-major] Brain Neoplasms / drug therapy. Brain Neoplasms / radiotherapy. Germinoma / drug therapy. Germinoma / radiotherapy
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Child. Chorionic Gonadotropin, beta Subunit, Human / secretion. Cisplatin / therapeutic use. Etoposide / therapeutic use. Female. Humans. Ifosfamide. Prognosis. Radiotherapy Dosage. Survival Rate. Treatment Outcome

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  • [CommentIn] J Clin Oncol. 2002 Jun 15;20(12):2911; author reply 2911-2 [12065573.001]
  • (PMID = 11821471.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Journal Article; Research Support, Non-U.S. Gov't
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin, beta Subunit, Human; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; UM20QQM95Y / Ifosfamide; ICE protocol 1; VP-P protocol
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7. Oyoshi T, Nakayama M, Hirano H, Shimokawa S, Kuratsu J: Intracranial dural metastasis of mediastinal seminoma--case report. Neurol Med Chir (Tokyo); 2000 Aug;40(8):423-6
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  • [Title] Intracranial dural metastasis of mediastinal seminoma--case report.
  • A 24-year-old male presented with a rare intracranial dural metastasis from a mediastinal germ cell tumor infiltrating the superior vena cava, pericardium, ascending aorta, and lung.
  • One year after the radiotherapy, magnetic resonance imaging revealed a right parasagittal tumor mimicking a meningioma.
  • Partial tumor removal was performed.
  • Two cycles of chemotherapy with carboplatin and etoposide were then performed, and the residual tumor almost completely disappeared.
  • The histological diagnosis of both the mediastinal and intracranial tumors was pure seminoma.
  • Sections of metastatic tumor revealed several thick fibrous septa and numerous epithelioid granulomas infiltrated by plasma cells, intermingled between the clusters of tumor cells.
  • [MeSH-minor] Adult. Combined Modality Therapy. Fatal Outcome. Humans. Magnetic Resonance Imaging. Male. Tomography, X-Ray Computed

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  • (PMID = 10979266.001).
  • [ISSN] 0470-8105
  • [Journal-full-title] Neurologia medico-chirurgica
  • [ISO-abbreviation] Neurol. Med. Chir. (Tokyo)
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] JAPAN
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8. Kochi M, Itoyama Y, Shiraishi S, Kitamura I, Marubayashi T, Ushio Y: Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors. J Neurosurg; 2003 Jul;99(1):106-14
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  • [Title] Successful treatment of intracranial nongerminomatous malignant germ cell tumors by administering neoadjuvant chemotherapy and radiotherapy before excision of residual tumors.
  • OBJECT: The goal of this study was to confirm the effectiveness of our novel treatment strategy, neoadjuvant therapy (NAT) consisting of combined chemo- and radiotherapy, which are performed before complete excision of residual tumor in patients with intracranial nongerminomatous malignant germ cell tumors (NGMGCTs).
  • METHODS: The authors treated 11 consecutive patients with NGMGCTs by applying NAT consisting of combined platinum-based chemotherapy and radiotherapy, followed by complete excision of residual tumors.
  • The pretreatment diagnosis, based on tumor markers with or without biopsy, was yolk sac tumor in five patients, embryonal carcinoma in one patient, immature teratoma in one patient, and mixed germ cell tumor containing malignant tumor components in four patients.
  • Residual tumors that occurred post-NAT were surgically removed in nine patients.
  • In one patient a leptomeningeal tumor recurred and he died of the disease 21 months after diagnosis.
  • CONCLUSIONS: Neoadjuvant therapy, consisting of combined chemo- and radiotherapy, followed by complete excision of residual tumors is highly effective in patients with intracranial NGMGCTs.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms. Carcinoma. Endodermal Sinus Tumor. Germinoma. Neoadjuvant Therapy / methods. Neoplasms, Germ Cell and Embryonal
  • [MeSH-minor] Adolescent. Adult. Biomarkers, Tumor. Biopsy. Child. Combined Modality Therapy. Disease Progression. Drug Administration Schedule. Female. Humans. Magnetic Resonance Imaging. Male. Neoplasm, Residual / pathology. Neoplasm, Residual / surgery. Postoperative Care. Quality of Life. Treatment Outcome

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  • (PMID = 12854751.001).
  • [ISSN] 0022-3085
  • [Journal-full-title] Journal of neurosurgery
  • [ISO-abbreviation] J. Neurosurg.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Biomarkers, Tumor
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9. Kellie SJ, Boyce H, Dunkel IJ, Diez B, Rosenblum M, Brualdi L, Finlay JL: Primary chemotherapy for intracranial nongerminomatous germ cell tumors: results of the second international CNS germ cell study group protocol. J Clin Oncol; 2004 Mar 1;22(5):846-53
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  • [Title] Primary chemotherapy for intracranial nongerminomatous germ cell tumors: results of the second international CNS germ cell study group protocol.
  • PURPOSE: The optimum therapy for intracranial nongerminomatous germ cell tumors (NGGCT) remains controversial.
  • The primary objective of this study was to determine whether intensive cisplatin and cyclophosphamide-based combination chemotherapy was effective in patients with intracranial NGGCT.
  • Initial therapy included two courses of Regimen A (cisplatin, etoposide, cyclophosphamide, and bleomycin).
  • Those in CR after four courses of treatment received one additional course of Regimen A and Regimen B, while those not in CR after four treatment courses underwent second-look surgery and/or irradiation.
  • RESULTS: Sixteen of 17 patients assessable for response after two courses of treatment achieved a CR or partial response (CR + partial response, 0.94; 95% CI, 0.73 to 1.0).
  • With a median follow-up of 6.3 years, 14 of 20 patients are alive without disease; eight patients were without relapse or progression, of whom three received local irradiation in first complete remission in violation of protocol, and six patients were in durable second or third complete remission after further chemotherapy and/or irradiation.
  • CONCLUSION: Intensive chemotherapy was effective in one-third of patients in this study.
  • Salvage therapy, including irradiation, was feasible in patients with recurrent disease.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Central Nervous System Neoplasms / drug therapy. Central Nervous System Neoplasms / pathology. Salvage Therapy
  • [MeSH-minor] Adolescent. Adult. Bleomycin / administration & dosage. Child. Child, Preschool. Cisplatin / administration & dosage. Cohort Studies. Confidence Intervals. Cyclophosphamide / administration & dosage. Disease-Free Survival. Dose-Response Relationship, Drug. Drug Administration Schedule. Etoposide / administration & dosage. Female. Germinoma. Humans. Infusions, Intravenous. International Cooperation. Male. Middle Aged. Probability. Prognosis. Prospective Studies. Risk Assessment. Statistics, Nonparametric. Survival Analysis. Treatment Outcome

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  • (PMID = 14990640.001).
  • [ISSN] 0732-183X
  • [Journal-full-title] Journal of clinical oncology : official journal of the American Society of Clinical Oncology
  • [ISO-abbreviation] J. Clin. Oncol.
  • [Language] eng
  • [Publication-type] Comparative Study; Journal Article
  • [Publication-country] United States
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; 8N3DW7272P / Cyclophosphamide; Q20Q21Q62J / Cisplatin
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10. Calaminus G, Bamberg M, Jürgens H, Kortmann RD, Sörensen N, Wiestler OD, Göbel U: Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant non-germinomatous germ cell tumors: results of the German Cooperative Trial MAKEI 89. Klin Padiatr; 2004 May-Jun;216(3):141-9
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  • [Title] Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant non-germinomatous germ cell tumors: results of the German Cooperative Trial MAKEI 89.
  • Malignant non-germinomatous intracranial germ cell tumors (MNGGCTs) are a heterogenous group of neoplastic lesions.
  • Their treatment concept follows a multimodal concept that may include tumor resection for local tumor control, craniospinal irradiation to cover leptomenigeal tumor spread and chemotherapy to eliminate systemic tumor dissemination.
  • A Platinum-based chemotherapy proven to be highly effective in testicular and non-testicular malignant germ cell tumors in adults as well as in children has also been chosen for intracranial sites.
  • While therapeutic concepts have been thoroughly evaluated for children and adolescents with extracranial nongonadal GCTs, no such detailed long term follow-up data are available for intracranial MNGGCTs.
  • This paper reports on the long-term outcome of 41 patients with intracranial malignant non-germinomatous GCTs enrolled into the German prospective protocol MAKEI 89.
  • The analysis focuses on the impact of surgery, radio- and chemotherapy.
  • PATIENTS AND METHODS: Between January 1989 and January 1994, 41 patients with malignant intracranial non-germinomatous GCTs were registered.
  • Patients were compared in respect to protocol (n = 27) and non-protocol treatment (n = 14).
  • Estimated were with chi (2) and Fisher exact test the impact of surgery, chemotherapy and irradiation on outcome.
  • RESULTS: The estimated (Kaplan-Meier) 5-year event free survival (EFS) of patients treated according to protocol recommendations was 0.59 +/- 0.06 (n = 27), compared to an EFS of 0.37 +/- 0.33 for patients with different treatments (n = 14) (p = 0.70, log-rank).
  • The 5-year relapse-free survival rate (RFS) was 0.74 +/- 0.06 in protocol patients and 0.38 +/- 0.33 in non-protocol patients (median observation time of 112 months after diagnosis for surviving patients) (p = 0.14, log-rank).
  • CONCLUSION: Cisplatin chemotherapy and craniospinal irradiation with tumor boost are of significant influence on long term survival in patients with MNGGCTs.
  • The exclusion of major surgery at diagnosis using modern advances in neurosurgery or related tumor resection after neoadjuvant chemotherapy will allow a further reduction of treatment related mortality and long lasting morbidity.
  • The analysis reveals that, given effective treatment, intracranial malignant non-germinomatous GCTs should not longer carry a poor prognosis.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / drug therapy. Brain Neoplasms / surgery. Cisplatin / administration & dosage. Cranial Irradiation. Neoadjuvant Therapy. Neoplasms, Germ Cell and Embryonal / drug therapy. Neoplasms, Germ Cell and Embryonal / surgery. Pinealoma / surgery
  • [MeSH-minor] Adolescent. Adult. Chemotherapy, Adjuvant. Child. Child, Preschool. Combined Modality Therapy. Disease-Free Survival. Female. Follow-Up Studies. Germany. Humans. Male. Prognosis. Prospective Studies. Radiotherapy, Adjuvant. Survival Analysis

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  • (PMID = 15175958.001).
  • [ISSN] 0300-8630
  • [Journal-full-title] Klinische Pädiatrie
  • [ISO-abbreviation] Klin Padiatr
  • [Language] eng
  • [Publication-type] Clinical Trial; Comparative Study; Controlled Clinical Trial; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't
  • [Publication-country] Germany
  • [Chemical-registry-number] Q20Q21Q62J / Cisplatin
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11. Smith AA, Weng E, Handler M, Foreman NK: Intracranial germ cell tumors: a single institution experience and review of the literature. J Neurooncol; 2004 Jun;68(2):153-9
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  • [Title] Intracranial germ cell tumors: a single institution experience and review of the literature.
  • There is little literature to guide therapy in children and young adults with intracranial germ cell tumors.
  • We present 17 consecutively diagnosed intracranial germ cell tumors at The Children's Hospital, Denver, from 1995 to 2001.
  • Two with suprasellar tumors presented with dementia, blindness and pan-hypopituitarism and another with recurrent subarachnoid hemorrhage.
  • Ten had non-germinomatous germ cell tumors (NGGCT), 5/10 were alpha feto-protein (AFP) positive only, one beta-human chorionic growth (betaHCG) factor positive only, 3 positive for AFP and betaHCG, and 1 malignant teratoma.
  • Therapy for metastatic patients consisted of chemotherapy followed by craniospinal radiation (CSI).
  • Patients with localized disease received chemotherapy followed by focal radiation.
  • Two patients received chemotherapy only, one because she died of sepsis while receiving chemotherapy and one because of neurologic injury incurred during surgery parents elected for no therapy.
  • Three patients have died, one of tumor recurrence, one from a remote complication of surgery and one of sepsis.
  • All five children with only AFP positivity, treated with chemotherapy and focal radiation are alive without evidence of disease at 10, 16, 22, 41 and 41 months.
  • Thus, there is little evidence that CSI is necessary in non-metastatic germinomas and AFP positive NGGCTs when combined chemotherapy and radiation therapy is used.
  • However, complications of delayed diagnosis, surgery and chemotherapy are important causes of mortality, with only one patient dying of tumor.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / pathology. Germinoma / pathology
  • [MeSH-minor] Adult. Child. Combined Modality Therapy. Humans. Retrospective Studies

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  • [Cites] J Neurooncol. 1998 May;37(3):229-39 [9524081.001]
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  • (PMID = 15218952.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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12. Isaacs H Jr: Perinatal (fetal and neonatal) germ cell tumors. J Pediatr Surg; 2004 Jul;39(7):1003-13
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  • [Title] Perinatal (fetal and neonatal) germ cell tumors.
  • BACKGROUND/PURPOSE: Germ cell tumors are relatively common in the fetus and neonate and are the leading neoplasms in some perinatal reviews.
  • The purpose of this study is to focus on the fetus and neonate in an attempt to determine the various ways germ cell tumors differ clinically and morphologically from those occurring in the older child and adult and to show that certain types of tumors have a better prognosis than others.
  • METHODS: The author conducted a retrospective review of perinatal teratomas and other germ cell tumors reported in the literature and of patients treated and followed up at Children's Hospital San Diego and Children's Hospital Los Angeles.
  • The incidence of teratoma with yolk sac tumor either at presentation or at recurrence was 5.8%, and the survival rate was 39%.
  • Sacrococcygeal teratomas had the highest incidence of yolk sac tumor at 10%.
  • Recurrent disease in the form of either teratoma or yolk sac tumor developed in 5% of patients.
  • CONCLUSIONS: Some germ cell tumors of the fetus and neonate have a better prognosis than others.
  • Neonates with gastric teratomas have the best survival rates, and those with intracranial germ cell tumors the worst.
  • Fetuses with teratomas detected antenatally have 3 times the mortality rate compared with postnatally diagnosed neonates.
  • Surgical resection alone may be adequate therapy for teratomas with nonmetastatic, microscopic foci of yolk sac tumor.
  • In the nonteratoma group, patients with pure yolk sac tumor and gonadoblastoma have a much better outcome than those with choriocarcinoma, which has a very low survival of rate of 12%.
  • Currently, the use of platinum-based combination chemotherapy has significantly improved the survival rate of infants with advanced malignant germ cell tumor disease.
  • [MeSH-major] Abnormalities, Multiple / epidemiology. Fetal Diseases / classification. Fetal Diseases / epidemiology. Head and Neck Neoplasms / epidemiology. Neoplasms, Germ Cell and Embryonal / classification. Neoplasms, Germ Cell and Embryonal / epidemiology
  • [MeSH-minor] Brain Neoplasms / epidemiology. Comorbidity. Digestive System Neoplasms / epidemiology. Endodermal Sinus Tumor / epidemiology. Female. Humans. Infant. Infant, Newborn. Los Angeles / epidemiology. Male. Neoplasm Recurrence, Local / epidemiology. Retrospective Studies. Sacrococcygeal Region. Spinal Neoplasms / epidemiology. Survival Rate. Teratoma / epidemiology. Ultrasonography, Prenatal

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  • (PMID = 15213888.001).
  • [ISSN] 1531-5037
  • [Journal-full-title] Journal of pediatric surgery
  • [ISO-abbreviation] J. Pediatr. Surg.
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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13. Shinoda J, Sakai N, Yano H, Hattori T, Ohkuma A, Sakaguchi H: Prognostic factors and therapeutic problems of primary intracranial choriocarcinoma/germ-cell tumors with high levels of HCG. J Neurooncol; 2004 Jan;66(1-2):225-40
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  • [Title] Prognostic factors and therapeutic problems of primary intracranial choriocarcinoma/germ-cell tumors with high levels of HCG.
  • OBJECTIVE: Primary intracranial choriocarcinoma (PICCC)/germ-cell tumors (GCTs) with high levels of human chorionic gonadotropin (HCG) (PICCC/GCTs with HL-HCG) are rare and malignant.
  • The goal of this study was to report our 3 cases of PICCC/GCTs with HL-HCG and to review the literature to elucidate the clinical problems and prognostic factors and to discuss the therapeutic modalities of this rare tumor.
  • Significance of the differences among survival curves concerning each parameter (age, sex, tumor location, serum HCG/beta-HCG level, precocious puberty, extent of surgery, radiotherapy, chemotherapy, mixture of other non-germinomatous GCT elements and extraneural metastasis) was tested using univariate and multivariate analyses.
  • RESULTS: The median survival time and the 1- and 2-year survival rates were 22 months, 61.2% and 49.8%, respectively.
  • In univariate analysis, male, subtotal removal or more, radiotherapy and chemotherapy were revealed to be significantly good prognostic factors.
  • However, suprasellar region and tumor hemorrhage were poor prognostic factors.
  • Multivariate analysis showed that extent of surgery, radiotherapy and chemotherapy were independent prognostic factors.
  • CONCLUSIONS: Although, we should mind the limitations of this study design because of case selection bias, different treatment protocols and incomplete follow-up of patients, this study led the following results and suggestive conclusions.
  • Tumor hemorrhage and progressive extraneural and cerebrospinal fluid metastasis were characteristic clinical problems of PICCC/GCTs with HL-HCG.
  • Initial biopsy and radiotherapy may lead to tumor hemorrhage.
  • To prevent tumor hemorrhage, gross tumor removal followed by radiotherapy and chemotherapy should be aimed for.
  • A few courses of chemotherapy before surgery may prevent metastasis.
  • Stereotactic radiotherapy and high dose chemotherapy may be promising options for treatment.
  • [MeSH-major] Brain Neoplasms / metabolism. Brain Neoplasms / therapy. Choriocarcinoma / metabolism. Choriocarcinoma / therapy. Chorionic Gonadotropin / metabolism. Germinoma / metabolism. Germinoma / therapy
  • [MeSH-minor] Adolescent. Adult. Child. Humans. Magnetic Resonance Imaging. Male. Prognosis. Survival Analysis

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  • (PMID = 15015791.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Journal Article; Review
  • [Publication-country] United States
  • [Chemical-registry-number] 0 / Chorionic Gonadotropin
  • [Number-of-references] 82
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14. Kanamori M, Kumabe T, Saito R, Yamashita Y, Sonoda Y, Ariga H, Takai Y, Tominaga T: Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis. J Neurosurg Pediatr; 2009 Dec;4(6):506-14
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  • [Title] Optimal treatment strategy for intracranial germ cell tumors: a single institution analysis.
  • OBJECT: This study retrospectively analyzed the long-term outcomes of 108 consecutive patients to establish the classification and optimal treatment strategy for each subgroup of newly diagnosed germ cell tumors (GCTs).
  • METHODS: A retrospective review of medical records from the authors' department between April 1989 and March 2007 identified 108 patients with newly diagnosed intracranial GCT.
  • Recurrences developed during a range of 6 to 153 months (median 26 months) after starting the initial therapy.
  • Patients treated only with chemotherapy demonstrated a shorter PFS rate, and patients treated with chemotherapy followed by reduced-dose radiation therapy to the whole ventricle, whole brain, or craniospinal axis showed significantly better PFS than patients treated with only radiation or reduced-dose radiation therapy to the focal field.
  • Nongerminomatous GCTs were divided into good, intermediate, and poor prognosis groups as proposed by the Japanese Pediatric Brain Tumor Study Group.
  • All patients with NGGCTs, in whom the lesions on MR imaging disappeared after combination therapies consisting of resection, radiation therapy, and chemotherapy, remained alive.
  • CONCLUSIONS: Chemotherapy followed by reduced-dose radiation therapy covering the whole ventricle improves the prognosis for patients with germinoma.
  • Combined therapy of radiation therapy, chemotherapy, and radical resection as an initial or salvage treatment achieved excellent tumor control in the intermediate prognosis NGGCT group.
  • The outcomes were still dismal in the poor prognosis NGGCT group, so initial therapy should target complete disappearance of all lesions on MR imaging.
  • [MeSH-major] Brain Neoplasms / drug therapy. Brain Neoplasms / surgery. Germinoma / drug therapy. Germinoma / surgery. Neoplasms, Germ Cell and Embryonal / drug therapy. Neoplasms, Germ Cell and Embryonal / surgery. Radiotherapy, Adjuvant
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Combined Modality Therapy. Disease-Free Survival. Female. Follow-Up Studies. Humans. Infant. Kaplan-Meier Estimate. Longitudinal Studies. Magnetic Resonance Imaging. Male. Middle Aged. Neurosurgical Procedures. Radiation Dosage. Retrospective Studies. Treatment Outcome. Young Adult

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  • (PMID = 19951035.001).
  • [ISSN] 1933-0715
  • [Journal-full-title] Journal of neurosurgery. Pediatrics
  • [ISO-abbreviation] J Neurosurg Pediatr
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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15. Huang X, Zhang R, Zhou LF: [Grading system for diagnosis and treatment of intracranial nongerminomatous malignant germ cell tumors]. Zhonghua Yi Xue Za Zhi; 2009 Sep 8;89(33):2333-6
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  • [Title] [Grading system for diagnosis and treatment of intracranial nongerminomatous malignant germ cell tumors].
  • OBJECTIVE: To discuss the clinical feature, treatment and prognosis of intracranial nongerminomatous malignant germ cell tumors (NGMGCT).
  • METHODS: The records of 39 patients receiving treatment at our hospital between 1995 and 2007 were reviewed retrospectively.
  • According to the classification of Matsutani, they were grouped into intermediate prognosis and poor prognosis groups based on tumor histology.
  • Clinical manifestations, diagnosis, treatment and outcome were analyzed in each group.
  • RESULTS: In these 39 cases, there were 15 mix germ cell tumors, 15 immature teratomas, 7 embryonal carcinomas and 2 yolk sac tumors.
  • The tumor was totally removed in 29 cases, sub-totally in 5 and partially in 3.
  • Embryonal carcinoma can be classified to the intermediate prognosis group because of its similar prognosis with immature teratoma and mixed tumors composed mainly of germinoma or teratoma.
  • Surgery remains the first choice for NGMGCT since treatment should be based on tumor histology.
  • For patients in the intermediate prognosis group, a combined regimen of surgical resection, radiotherapy, chemotherapy and gamma knife surgery is mostly effective.
  • [MeSH-major] Brain Neoplasms / classification. Neoplasms, Germ Cell and Embryonal / classification
  • [MeSH-minor] Adolescent. Adult. Chemotherapy, Adjuvant. Child. Child, Preschool. Female. Humans. Male. Prognosis. Radiotherapy, Adjuvant. Retrospective Studies. Treatment Outcome. Young Adult

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  • (PMID = 20095355.001).
  • [ISSN] 0376-2491
  • [Journal-full-title] Zhonghua yi xue za zhi
  • [ISO-abbreviation] Zhonghua Yi Xue Za Zhi
  • [Language] chi
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] China
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16. Kumabe T, Kusaka Y, Jokura H, Ikeda H, Shirane R, Yoshimoto T: [Recurrence of intracranial germinoma initially treated with chemotherapy only]. No Shinkei Geka; 2002 Sep;30(9):935-42
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  • [Title] [Recurrence of intracranial germinoma initially treated with chemotherapy only].
  • Irradiation for intracranial germinoma may be associated with significant neuroendocrinological sequelae, so the establishment of lower effective doses of radiation is desirable.
  • Eight consecutive patients with intracranial germinoma underwent combination chemotherapy with BEP (bleomycin, etoposide, and cisplatin) or PE (cisplatin and etoposide) without irradiation between 1996 and 1997.
  • These 7 patients obtained complete response (CR) after treatment with chemotherapy only.
  • The diagnosis of pure germinoma was based on neuroradiographic appearances and the normal levels of tumor markers in patients with suprasellar and pineal-region germ cell tumors.
  • Although all patients obtained CR, 5 patients relapsed at a mean period of 19 months after the initial therapy.
  • Additional chemotherapy and total ventricle irradiation (24 Gy) achieved CR, but delayed seeding in the optic nerves outside the irradiated field was detected.
  • One patient suffered peritoneal dissemination via a ventriculoperitoneal shunt with intracranial dissemination.
  • Another patient obtained CR after PE therapy, but there was not histological verification.
  • However, 35 months after the initial therapy, surgical extirpation of the recurrent tumor revealed immature teratoma.
  • One patient refused treatment for recurrence at the initial tumor site and died 42 months after the initial treatment.
  • Adequate initial therapy is absolutely essential for the treatment of intracranial germinoma.
  • The chemotherapy regimens in use today cannot be recommended as initial therapy without irradiation because of the high recurrence rates.
  • [MeSH-major] Brain Neoplasms / drug therapy. Germinoma / drug therapy. Neoplasm Recurrence, Local
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / administration & dosage. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Bleomycin / administration & dosage. Child. Cisplatin / administration & dosage. Etoposide / administration & dosage. Fatal Outcome. Follow-Up Studies. Humans. Male. Radiotherapy, Adjuvant. Treatment Outcome

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  • (PMID = 12233091.001).
  • [ISSN] 0301-2603
  • [Journal-full-title] No shinkei geka. Neurological surgery
  • [ISO-abbreviation] No Shinkei Geka
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 11056-06-7 / Bleomycin; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; BEP protocol
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17. Friedman JA, Lynch JJ, Buckner JC, Scheithauer BW, Raffel C: Management of malignant pineal germ cell tumors with residual mature teratoma. Neurosurgery; 2001 Mar;48(3):518-22; discussion 522-3
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  • [Title] Management of malignant pineal germ cell tumors with residual mature teratoma.
  • OBJECTIVE: The treatment of intracranial mixed germ cell tumors presents a unique challenge, since eradication of malignant tumor by radiation and/or chemotherapy may spare the benign tumor component.
  • We reviewed our surgical experience with residual malignant pineal germ cell tumors after neoadjuvant therapy.
  • METHODS: Between 1987 and 1997, 16 patients with malignant intracranial germ cell tumors were treated at the Mayo Clinic with a protocol of neoadjuvant chemotherapy and radiation therapy.
  • After the diagnosis was confirmed by histopathological examination, all patients were treated with four cycles of etoposide and cisplatin as well as external beam radiation therapy (range, 3030-5940 cGy).
  • Six patients had an incomplete response to therapy, as demonstrated by observation of residual tumor on magnetic resonance imaging scans.
  • Initial pathology in these six patients was germinoma in four and combinations of yolk sac tumor, embryonal carcinoma, malignant teratoma, and germinoma in two.
  • Two patients had synchronous pineal and suprasellar tumors, with leptomeningeal dissemination.
  • Tumor markers were elevated in four of the six patients at presentation.
  • RESULTS: All patients with residual pineal tumors underwent surgical resection via an infratentorial, supracerebellar approach.
  • CONCLUSION: Residual pineal tumor occurring after treatment of malignant intracranial germ cell tumor with neoadjuvant therapy is likely to be mature teratoma.
  • [MeSH-minor] Adolescent. Adult. Algorithms. Child. Combined Modality Therapy. Female. Follow-Up Studies. Humans. Male. Neoplasm, Residual


18. Vuillermet P, Cauliez B, Fréger P, Vannier JP, Pellerin A, Kuhn JM: Simultaneous suprasellar and pineal germ cell tumors in five late stage adolescents: endocrinological studies and prolonged follow-up. J Pediatr Endocrinol Metab; 2008 Dec;21(12):1169-78
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  • [Title] Simultaneous suprasellar and pineal germ cell tumors in five late stage adolescents: endocrinological studies and prolonged follow-up.
  • Primary germ cell tumors (PGCT) of the central nervous system usually develop in the third ventricle area, and most frequently in the pineal region.
  • The suprasellar region is the second preferential site for development of these tumors which are rarely simultaneously present in these two sites.
  • The clinical picture associated signs of intracranial hypertension, convergence and verticality palsies, diabetes insipidus and pituitary deficiency.
  • Following identification of the pathological type of lesions via a neurosurgical approach, treatment was based on a combined method using chemotherapy, radiotherapy and hormone replacement.
  • Based on this treatment, prolonged remissions were obtained with a good quality of life.
  • [MeSH-major] Brain Neoplasms / diagnosis. Hypothalamo-Hypophyseal System / metabolism. Neoplasms, Germ Cell and Embryonal / diagnosis. Neoplasms, Multiple Primary / diagnosis. Pinealoma / diagnosis. Pituitary Neoplasms / diagnosis
  • [MeSH-minor] Adolescent. Adrenocorticotropic Hormone / blood. Combined Modality Therapy. Drug Therapy. Female. Follow-Up Studies. Gonadal Steroid Hormones / blood. Growth Hormone / blood. Hormone Replacement Therapy. Humans. Hydrocortisone / blood. Male. Pineal Gland / pathology. Prognosis. Radiotherapy. Thyrotropin / blood. Young Adult

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  • (PMID = 19189691.001).
  • [ISSN] 0334-018X
  • [Journal-full-title] Journal of pediatric endocrinology & metabolism : JPEM
  • [ISO-abbreviation] J. Pediatr. Endocrinol. Metab.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] England
  • [Chemical-registry-number] 0 / Gonadal Steroid Hormones; 9002-60-2 / Adrenocorticotropic Hormone; 9002-71-5 / Thyrotropin; 9002-72-6 / Growth Hormone; WI4X0X7BPJ / Hydrocortisone
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19. Sonoda Y, Kumabe T, Sugiyama S, Kanamori M, Yamashita Y, Saito R, Ariga H, Takai Y, Tominaga T: Germ cell tumors in the basal ganglia: problems of early diagnosis and treatment. J Neurosurg Pediatr; 2008 Aug;2(2):118-24
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  • [Title] Germ cell tumors in the basal ganglia: problems of early diagnosis and treatment.
  • OBJECT: Intracranial germ cell tumors (GCTs) originating in the basal ganglia are rare.
  • The authors investigated factors related to the diagnosis of these lesions as well as outcome in order to help decrease the time to diagnosis and improve treatment efficacy.
  • METHODS: The authors reviewed the clinical features of 142 cases of intracranial GCT in their institute.
  • The symptoms, neuroimaging findings, delay between symptom onset and diagnosis or treatment, initial and further treatment, and outcome were investigated.
  • Despite good response to the initial therapy, 5 patients experienced recurrence; 2 of these 5 had malignant GCTs, and 3 had been treated only with chemotherapy or radiochemotherapy with insufficient radiation dose and field.
  • Since insufficient treatment resulted in early recurrence, radiation therapy with adequate dose and field is essential.
  • [MeSH-major] Basal Ganglia. Brain Neoplasms / diagnosis. Brain Neoplasms / therapy. Neoplasms, Germ Cell and Embryonal / diagnosis. Neoplasms, Germ Cell and Embryonal / therapy
  • [MeSH-minor] Adolescent. Adult. Child. Cohort Studies. Combined Modality Therapy. Early Diagnosis. Female. Humans. Magnetic Resonance Imaging. Male. Retrospective Studies. Treatment Outcome

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  • (PMID = 18671616.001).
  • [ISSN] 1933-0707
  • [Journal-full-title] Journal of neurosurgery. Pediatrics
  • [ISO-abbreviation] J Neurosurg Pediatr
  • [Language] eng
  • [Publication-type] Journal Article
  • [Publication-country] United States
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20. Matsumoto J, Kochi M, Morioka M, Nakamura H, Makino K, Hamada J, Kuratsu J, Ushio Y: A long-term ventricular drainage for patients with germ cell tumors or medulloblastoma. Surg Neurol; 2006 Jan;65(1):74-80; discussion 80
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  • [Title] A long-term ventricular drainage for patients with germ cell tumors or medulloblastoma.
  • BACKGROUND: Hydrocephalus associated with intracranial germ cell tumors or disseminated medulloblastoma has been treated with ventriculoperitoneal shunt.
  • However, this procedure has a potential risk of intraperitoneal metastasis of these brain tumors.
  • To prevent this potential risk and to minimize the risk of infection, we developed a percutaneous long-tunneled ventricular drainage (PLTVD).
  • To confirm the effectiveness, we retrospectively analyzed the results of this procedure.
  • METHODS: From 1979 to 2003, we have treated 96 patients with germ cell tumors and medulloblastoma in our hospital.
  • Of 96 patients, 59 (germ cell tumor, 31; medulloblastoma, 28) had hydrocephalus and 13 needed long-term cerebrospinal fluid drainage to manage the obstructive hydrocephalus due to persistent tumor or communicating hydrocephalus due to dissemination.
  • All 13 cases received full-dose chemotherapy and radiotherapy without infectious complications or extraneural metastasis.
  • CONCLUSIONS: Percutaneous long-tunneled ventricular drainage was an effective method to manage long-lasting obstructive or communicating hydrocephalus with germ cell tumors and medulloblastoma.
  • [MeSH-major] Brain Neoplasms / complications. Hydrocephalus / etiology. Hydrocephalus / surgery. Medulloblastoma / complications. Neoplasms, Germ Cell and Embryonal / complications. Ventriculoperitoneal Shunt
  • [MeSH-minor] Adolescent. Adult. Child. Child, Preschool. Female. Humans. Incidence. Infant. Infection / epidemiology. Male. Postoperative Complications / epidemiology. Retrospective Studies. Time Factors


21. Kunishio K, Okada M, Miyake K, Matsumoto Y, Nagao S, Nishiyama Y, Ohkawa M: [Report of two cases with germinoma treated by individual adjuvant chemotherapy based on the mRNA expression of drug-resistance gene]. No Shinkei Geka; 2004 Jan;32(1):19-26
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  • [Title] [Report of two cases with germinoma treated by individual adjuvant chemotherapy based on the mRNA expression of drug-resistance gene].
  • We reported two cases with germ cell tumor in which new preliminary treatment trials were performed by chemotherapy using anti-cancer drug selected on the basis of multidrug resistance gene mRNA expression, such as MDR1, MRP1, MRP2, MXR1, MGMT, GST pi and TopoII alpha, from RT-PCR assay.
  • A 28-year-old male had gradually developed DI.
  • MR imaging revealed enhanced tumors in the medulla oblongata, the pineal region and the suprasella region.
  • Biopsy of tumor in the medulla oblongata demonstrated germinoma histologically.
  • RT-PCR assay of this tissue revealed overexpression of MRP1, MGMT and GST pi mRNA, but neither MDR1, MRP2 nor MXR1 was observed.
  • A 15-year-old male was admitted to our hospital with high intracranial pressure syndrome.
  • MR imaging revealed enhanced tumor in the pineal region.
  • The tumor was diagnosed as a malignant germ cell tumor, histopathologically.
  • RT-PCR assay of this tissue revealed overexpression of MRP1, MRP2, MXR1, MGMT and GST pi mRNA.
  • The patient was treated by irradiation including radiosurgery combined with chemotherapy, given cisplatin, etoposide and ifosphamide (ICE regimen), but he died because of progressive disease such as CSF dissemination.
  • It seems that preliminary individual adjuvant chemotherapy based on mRNA expression of drug-resistance gene is available for the treatment of germ cell tumors.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Brain Neoplasms / genetics. Brain Neoplasms / therapy. Drug Resistance, Neoplasm / genetics. Gene Expression. Genes, MDR / genetics. Germinoma / genetics. Germinoma / therapy. RNA, Messenger
  • [MeSH-minor] Adolescent. Adult. Chemotherapy, Adjuvant. Cisplatin / administration & dosage. Etoposide / administration & dosage. Fatal Outcome. Humans. Ifosfamide / administration & dosage. Male. Pharmacogenetics. Treatment Outcome

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  • (PMID = 14978920.001).
  • [ISSN] 0301-2603
  • [Journal-full-title] No shinkei geka. Neurological surgery
  • [ISO-abbreviation] No Shinkei Geka
  • [Language] jpn
  • [Publication-type] Case Reports; English Abstract; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / RNA, Messenger; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; UM20QQM95Y / Ifosfamide
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22. Kanamori M, Kumabe T, Saito R, Yamashita Y, Sonoda Y, Tominaga T: [The safety of combination chemotherapy with ifosfamide, cisplatin, and etoposide (ICE): single-institution retrospective review of 108 cases]. No Shinkei Geka; 2010 Nov;38(11):997-1005
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  • [Title] [The safety of combination chemotherapy with ifosfamide, cisplatin, and etoposide (ICE): single-institution retrospective review of 108 cases].
  • PURPOSE: The adverse effects of combination chemotherapy of ifosfamide, cisplatin, and etoposide (ICE) were evaluated in the treatment of various intracranial brain tumors.
  • The histological diagnosis was newly diagnosed or recurrent germ cell tumor in 45 cases, medulloblastoma in 19, primitive neuroectodermal tumor (PNET) in 7, anaplastic ependymoma in 6, recurrent glioblastoma in 13, and others in 18 cases.
  • Patients received 1-8 cycles of ICE chemotherapy with or without radiation therapy.
  • [MeSH-major] Antineoplastic Combined Chemotherapy Protocols / adverse effects. Brain Neoplasms / drug therapy
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Agents / administration & dosage. Antineoplastic Agents / adverse effects. Antineoplastic Agents, Alkylating / administration & dosage. Antineoplastic Agents, Alkylating / adverse effects. Antineoplastic Agents, Phytogenic / administration & dosage. Antineoplastic Agents, Phytogenic / adverse effects. Child. Child, Preschool. Cisplatin / administration & dosage. Cisplatin / adverse effects. Ependymoma / drug therapy. Etoposide / administration & dosage. Etoposide / adverse effects. Female. Glioblastoma / drug therapy. Hematologic Diseases / chemically induced. Humans. Ifosfamide / administration & dosage. Ifosfamide / adverse effects. Infant. Male. Medulloblastoma / drug therapy. Middle Aged. Neoplasms, Germ Cell and Embryonal / drug therapy. Neuroectodermal Tumors, Primitive / drug therapy. Retrospective Studies

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  • (PMID = 21081811.001).
  • [ISSN] 0301-2603
  • [Journal-full-title] No shinkei geka. Neurological surgery
  • [ISO-abbreviation] No Shinkei Geka
  • [Language] jpn
  • [Publication-type] English Abstract; Journal Article
  • [Publication-country] Japan
  • [Chemical-registry-number] 0 / Antineoplastic Agents; 0 / Antineoplastic Agents, Alkylating; 0 / Antineoplastic Agents, Phytogenic; 6PLQ3CP4P3 / Etoposide; Q20Q21Q62J / Cisplatin; UM20QQM95Y / Ifosfamide
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23. Kohyama S, Uematsu M, Ishihara S, Shima K, Tamai S, Kusano S: An experience of stereotactic radiation therapy for primary intracranial choriocarcinoma. Tumori; 2001 May-Jun;87(3):162-5
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  • [Title] An experience of stereotactic radiation therapy for primary intracranial choriocarcinoma.
  • We report on a patient with choriocarcinoma in the pineal region who was successfully treated with stereotactic radiation therapy (SRT).
  • The increased level of serum human chorionic gonadotropin (HCG) was lowered during chemotherapy with etoposide, cisplatin, and ifosfamide.
  • However, HCG was not normalized and magnetic resonance images still showed an enhanced tumor mass with gadolinium.
  • The patient underwent SRT of 40 Gy at an 80% isodose line per 10 fractions over two weeks, followed by conventional craniospinal irradiation of 32.4 Gy.
  • The level of HCG dropped below the detection limit.
  • The patient has been in good condition for more than four years after the completion of treatment, without any signs of recurrence.
  • We propose SRT as a valid treatment option for malignant germ cell tumors in the pineal region.
  • [MeSH-minor] Adult. Humans. Immunohistochemistry. Magnetic Resonance Imaging. Male. Tomography, X-Ray Computed. Treatment Outcome

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  • (PMID = 11504371.001).
  • [ISSN] 0300-8916
  • [Journal-full-title] Tumori
  • [ISO-abbreviation] Tumori
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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24. Nicolato A, Ria A, Foroni R, Manno P, Alessandrini F, Sava T, Lupidi F, Leone P, Maluta S, Cetto GL, Gerosa M: Gamma knife radiosurgery in brain metastases from testicular tumors. Med Oncol; 2005;22(1):45-56
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  • [Title] Gamma knife radiosurgery in brain metastases from testicular tumors.
  • To our knowledge, there are no published reports on the effectiveness of radiosurgery in the management of brain metastases from testicular nonseminomatous germ cell tumor.
  • The authors evaluate the results of gamma knife (GK) treatment in three patients with these unusual intracranial lesions.
  • Between April 1995 and July 2001, three patients with brain metastasis from testicular nonseminomatous germ cell tumor underwent adjuvant radiosurgery at our department.
  • The primary tumor had been surgically removed in all cases.
  • Chemotherapy and whole brain radiotherapy were administered before radiosurgery in all cases.
  • Pre-GK radiotherapy was administered with a daily fraction dosage of 1.8-2.0 Gy.
  • The indications for radiosurgery were tumor volume <20 cm3, microsurgery too risky, refusal of surgery.
  • Post-GK high-dose chemotherapy with autologous peripheral-blood stem-cell rescue was administered in two cases due to systemic recurrence of the disease.
  • Neuroradiological follow-up invariably showed tumor growth control (complete response in two cases and partial response in one) with typically delayed post-radiosurgical imaging changes (transient in two cases and long-lasting in one).
  • In conclusion, GK seems to be highly effective and safe in brain metastases from testicular nonseminomatous germ cell tumor.
  • In cases with diffuse metastatic brain involvement, the whole brain radiotherapy preceding radiosurgery should be delivered with 1.8 Gy daily fraction to prevent the risk of long-lasting post-radiosurgical imaging changes.
  • [MeSH-major] Brain Neoplasms / surgery. Neoplasms, Germ Cell and Embryonal / secondary. Radiosurgery / methods. Testicular Neoplasms / pathology
  • [MeSH-minor] Adolescent. Adult. Humans. Magnetic Resonance Imaging. Male

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  • (PMID = 15750196.001).
  • [ISSN] 1357-0560
  • [Journal-full-title] Medical oncology (Northwood, London, England)
  • [ISO-abbreviation] Med. Oncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] United States
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25. Sartori S, Laverda AM, Calderone M, Carollo C, Viscardi E, Faggin R, Perilongo G: Germinoma with synchronous involvement of midline and off-midline structures associated with progressive hemiparesis and hemiatrophy in a young adult. Childs Nerv Syst; 2007 Nov;23(11):1341-5
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  • [Title] Germinoma with synchronous involvement of midline and off-midline structures associated with progressive hemiparesis and hemiatrophy in a young adult.
  • INTRODUCTION: Cerebral germinomas, the most common and least malignant intracranial germ cell tumors, usually arise in the pineal or suprasellar region and have characteristic clinical and radiological features.
  • DISCUSSION: The literature is reviewed, and the pathogenesis, the clinical findings, the imaging, and the therapy are discussed.
  • [MeSH-minor] Adolescent. Adult. Antineoplastic Combined Chemotherapy Protocols / therapeutic use. Atrophy. Child. Functional Laterality. Humans. Male. Paresis / etiology. Thalamic Diseases / drug therapy. Thalamic Diseases / pathology. Treatment Outcome

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  • (PMID = 17609967.001).
  • [ISSN] 0256-7040
  • [Journal-full-title] Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery
  • [ISO-abbreviation] Childs Nerv Syst
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article
  • [Publication-country] Germany
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26. Kan P, Gottfried ON, Blumenthal DT, Liu JK, Salzman KL, Townsend J, Jensen RL: Primary spinal yolk sac tumor with brain metastasis: case report and review of the literature. J Neurooncol; 2006 Jul;78(3):249-53
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  • [Title] Primary spinal yolk sac tumor with brain metastasis: case report and review of the literature.
  • OBJECT: Central nervous system primary germ cell tumors are typically pineal or suprasellar.
  • Primary germ cell tumors of the spinal axis are very rare, with only a few case reports of germinomas and teratomas described in the literature.
  • METHODS: We present the unique case of a 25-year-old woman with an intradural, extramedullary primary yolk sac tumor (YST) at and below the level of the conus medullaris.
  • She was subsequently treated with four cycles of chemotherapy (intravenous cisplatin and etoposide), 40-Gy fractionated focal external beam radiation to the spine, and consolidation with four additional cycles of chemotherapy (intravenous carboplatin, vinblastine, etoposide, and bleomycin).
  • Despite an initial reduction in tumor size and clinical improvement in her neurologic exam, she re-presented a year after surgery with gross enlargement of her spinal tumor and CSF dissemination with metastasis to her brain.
  • Despite further chemotherapy and radiotherapy, the patient died from her disseminated YST.
  • CONCLUSIONS: This case demonstrates that primary YSTs may occur in the spine, and like their intracranial counterparts, are associated with poor prognosis and dissemination through the neuroaxis.
  • When feasible (no evidence of CSF dissemination, metastasis, or multifocal disease), optimal treatment includes as extensive resection of tumor as possible followed by adjuvant chemotherapy and radiation.
  • The authors review the available literature on the treatment of intracranial malignant germ cell tumors, extrapolated to apply to the much rarer spinal lesions.
  • [MeSH-major] Brain Neoplasms / secondary. Endodermal Sinus Tumor / secondary. Neoplasm Recurrence, Local / pathology. Spinal Neoplasms / pathology
  • [MeSH-minor] Adult. Fatal Outcome. Female. Humans

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  • (PMID = 16773223.001).
  • [ISSN] 0167-594X
  • [Journal-full-title] Journal of neuro-oncology
  • [ISO-abbreviation] J. Neurooncol.
  • [Language] eng
  • [Publication-type] Case Reports; Journal Article; Review
  • [Publication-country] United States
  • [Number-of-references] 16
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